| Catalyst Center Quarterly |
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 The Catalyst Center team thanks you for your support of our activities this past year. We've enjoyed working with you to provide technical assistance, collaborate on briefs and other projects, give presentations, conduct interviews, and bring you a roundup of news and events as we work together to improve financing of care and coverage for children and youth with special health care needs.
We look forward to continued, productive partnerships in 2015.
Wishing you a happy, healthy holiday season,
Sally, Meg, Angela, Beth, Edi, Kate, Melissa, and Kasey
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News from Our Partners
National Maternal and Child Health (MCH) Workforce Development Center Day of Learning
Date: January 28, 2015
Time: 10 am to 3 pm ET
Location: Hyatt Regency, Washington, D.C. The National MCH Workforce Development Center, in partnership with the Association of Maternal & Child Health Programs (AMCHP), is hosting an interactive Day of Learning immediately following the 2015 AMCHP Annual Conference in Washington DC. This Day of Learning is an opportunity to meet Center staff and learn about the services that the Center provides to support health transformation in the states and territories. There will be a variety of interactive activities to support state Title V transformation efforts, including:
- Learning what the Center has accomplished and its plans for the coming year
- Learning about the state-specific projects the Center helped support through intensive training and technical assistance
- Designing a customized package of workforce development services for your state or territory
- Receiving individualized guidance, if interested in applying for the Center's second round of intensive training
AMCHP will pay for the extra night of hotel expenses for two representatives (i.e., a MCH, Title V or CYSHCN Director) from each state and territory. There is still time to complete the National MCH Workforce Development Center Registration for this event. Contact Ki'Yonna Jones for more information.
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| Media Highlights
By Kathleen Noonan, Aimee M. Grace, Genevieve M. Kenney and Sara Rosenbaum
The Hill
December 18, 2014
Authorizing continued funding for the Children's Health Insurance Program (CHIP) will ensure children without access to other affordable health insurance will retain health care coverage. But there are other issues that jeopardize children's coverage. These include:
- The lack of national standards for pediatric health services, other than for oral and vision care--the benchmark plan approach for defining the essential health benefits for plans sold through the Marketplace and for new individual and small-group plans sold outside of the Marketplace means there is marked state-to-state variability in pediatric benefits.
- The family glitch
- Cost-sharing for Marketplace plans is significantly higher than cost-sharing for CHIP.
These authors note the need for national standards for pediatric benefits, resolution of the family glitch, and improved cost-sharing for families whose children are enrolled in Marketplace plans.
By Michelle Andrews
Kaiser Health News
December 19, 2014
A health plan deductible is the amount of money an individual or family must pay out of pocket before the health insurer begins reimbursing its share for covered services. Did you know there are different kinds of deductibles? For families raising children and youth with special health care needs (CYSHCN), knowing the difference between an aggregate and an embedded deductible can make a difference in their out-of-pocket expenses. If the deductible is aggregate, the family must pay the entire amount before the insurer begins paying. However, if the deductible is embedded, the total amount of the deductible is the same, but the insurer will start paying for services used by family members who have met their individual deductible. CYSHCN generally use more health services than other family members do. Once the individual deductible is met for that family member, the insurer will start paying its share for the child's services. So an embedded deductible means insurance begins paying for covered medical expenses for CYSHCN before the entire deductible is met.
By Ashley Blackburn
Health Policy Hub
December 18, 2014
On November 26, 2014, the Centers for Medicare and Medicaid Services (CMS) released the Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2016. This proposed rule includes Network Adequacy Standards. This blog provides an overview of some of the new network adequacy requirements. In order to increase the number of health care providers in low-income and racially diverse communities, Essential Community Providers can now include "state-owned, government, and not-for-profit facilities including family-planning service sites, regardless of whether the providers receive federal funding under specific federal programs." Provider directories have to be updated monthly, and consumers must be able to access this information without logging into the Marketplace. The National Association of Insurance Commissioners (NAIC) is revising its model for network adequacy, which CMS will use to finalize the rule. Until that time, CMS has stated that network adequacy determinations cannot include out-of-network providers. In addition, the NAIC has made some recommendations to improve the oversight of networks. Some of these recommendations, such as protections to ensure continuity of care, are particularly important for children and youth with special care needs, who need to be able to continue to receive care from specialty providers, many of whom have been providing their care since birth. By Gary Claxton, Rabah Kamal, and Cynthia Cox
Kaiser Family Foundation
December 17, 2014
This study, using data from the 2012 Medical Expenditure Panel Survey (MEPS), examined differences in health care spending across demographic characteristics, which included age, gender, race, and insurance status. In 2012, 25% of the population was younger than 19 and accounted for 11% of the total spending on health care. Spending was higher for boys than for girls. When the authors examined costs by race, they found spending was highest for white children, followed by Hispanic, Black, and Asian children. Children with insurance had higher health care costs than those who were uninsured, and children with private insurance had higher health care costs than children with public coverage. By Aaron E. Carroll
New York Times
December 1, 2015
A priority of the Affordable Care Act (ACA) is to enroll the uninsured into health care coverage. However, as noted in this article, many people continue to forgo care because they cannot afford their health plan's deductibles and other out-of-pocket expenses. So, even though more people have health insurance, because they are underinsured (which is defined as spending more than 5% of household income for families that earn less than 200% of the federal poverty level), many family members do not get needed tests and treatments and skip follow-up care and preventive visits. The author is concerned that adding copper-level health plans to the choice of Marketplace plans will exacerbate the problem of underinsurance, as these plans would have even higher deductibles and would cover only 50% of the cost of health services. This article focuses on adults ages 19 and older, but high-deductible health plans and underinsurance are concerns for children too, especially for children and youth with special health care needs (CYSHCN). In April of this year, the American Academy of Pediatrics issued a High-Deductible Health Plans policy statement, noting the implications for CYSHCN. Patients are not the only ones who are feeling the effects of high-deductible health plans. The next article highlights the effect of high-deductible health plans on providers.
By Steve Twedt
St. Louis Post-Dispatch
December 1, 2015
Independent medical practices in Pittsburgh are seeing an uptick in the number of patients who are unable to pay the out-of-pocket costs of care, which include meeting the deductible, due at the time of the visit. Providers walk a fine line to ensure their patients do not forgo health care, while balancing the administrative burden of uncompensated care and their own financial health.
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Racial/Ethnic Differences in Uninsurance Rates under the ACA
By Lisa Clemans-Cope, Matthew Buettgens, and Hannah Recht
The Urban Institute
December 2014
These authors from the Urban Institute have created a research report, brief, map, and blog that highlight the importance of the Medicaid expansion in decreasing the coverage gap between whites and other racial and ethnic groups, with the exception of blacks. The interactive infographic, Mapping uninsurance by race/ethnicity: three scenarios, lets users see the difference in coverage rates for White, Latino, Black, Asian/Pacific Islander, and American Indian/Native Indian populations without the Affordable Care Act (ACA), in states that have expanded Medicaid, and if every state expands Medicaid.
Vision Services for Children on Medicaid: A Review of EPSDT Services
By Jane Perkins and Catherine McKee
National Health Law Program (NHeLP)
November 25, 2014
Early and Periodic Screening, Diagnostics and Treatment (EPSDT) is a comprehensive Medicaid benefit that every Medicaid program must provide to eligible children, birth to 21. Vision services are included in EPSDT, yet many children who are eligible for Medicaid have undiagnosed vision problems. This problem is especially prevalent among children of color. This issue brief from the National Health Law Program provides an overview of the scope of the problem and common eye conditions, many of which can be successfully treated if diagnosed and treated early, and a comprehensive discussion of the Medicaid benefit and state implementation of EPSDT requirements for vision services. There are also recommendations for states to improve vision services, such as establishing a schedule for vision screenings; educating managed care entities, participating providers, and families about the importance of vision screenings; using age-appropriate vision tests; and adding a child vision screening quality measure for Medicaid and the Children's Health Insurance Programs (CHIP).
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Announcements & Events
How to Enroll in the Health Insurance Marketplace
Date: January 13, 2015
Time: 2 pm ET
To Join By Phone Only: Dial: 914-339-0033, Access Code: 432-745-342 (For those joining by phone only, the Pin Number is the # key)
Open enrollment ends on February 15, 2015. In order for coverage to begin by February 1, consumers must enroll by January 15. This webinar, hosted by the HHS Partnership Center and the Centers for Medicare & Medicaid Services, is an opportunity to learn how to enroll in Marketplace coverage. Presenters will also share key websites and other resources about the Affordable Care Act (ACA) law. Send questions in advance to ACA101@hhs.gov by January 13 at 12 noon ET. Register for the webinar How to Enroll in the Health Insurance Marketplace.
Webinar recording: A Walk in Someone Else's Shoes: Payment Reform Perspectives from Providers and Private Payers
On December 15, 2014, the National Academy for State Health Policy (NASHP) hosted a webinar where a primary care provider and representatives from a commercial health plan, a self-funded plan, and a large health system discussed their interactions with delivery and payment transformation efforts in their states. They shared the challenges they faced and how all stakeholders can work together to implement payment reform initiatives. Watch the Webinar Recording: A Walk in Someone Else's Shoes: Payment Reform Perspectives from Providers and Private Payers.
Webinar recording: Strategies to Increase Oral Health Care Access for Children in Medicaid: Lessons from Pioneering States
Since March 2013, the Center for Health Care Strategies (CHCS) has been leading a multi-state learning collaborative for Medicaid teams in seven states. The goal was to improve access to oral health care for children enrolled in Medicaid. During this webinar, presented on December 18, 2014, representatives from the state teams shared their strategies for improving oral health care access, quality improvement frameworks, and plans for building on their early successes to maximize oral health services, which are part of the Medicaid Early and Periodic Screening, Diagnostics and Treatment (EPSDT) benefit. Download the agenda and the presentation, and watch the webinar recording Strategies to Increase Oral Health Care Access for Children in Medicaid: Lessons from Pioneering States.
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The Catalyst Center, the National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs, is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U41MC13618, $473,000). This information or content and conclusions are those of the Catalyst Center staff and should not be construed as the official position or policy of nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. LT Leticia Manning, MPH, MCHB/HRSA Project Officer. For more information, please visit us at www.catalystctr.org or contact Meg Comeau, Co-Principal Investigator, at mcomeau@bu.edu.
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